Pyloric Stenosis Care

Pyloric stenosis is a thickening of the muscle at the end of the stomach that can block or slow down food going from the stomach to the small intestine. This thickening of the muscle can cause a baby to vomit, often in a forceful way, called projectile vomiting. It is a common problem that affects babies usually 2 weeks to 3 months old.

A doctor will check your baby’s stomach with their hands to feel for the thickened muscle. Your baby may have an ultrasound or contrast study to check for a thickened stomach muscle or to find other possible causes of vomiting.

Your baby will need surgery to open the thickened muscle and the passage from the stomach to the intestine.

Before surgery your baby will have blood tests, and get fluids through their veins, called IV (intravenous), to replace fluid lost from vomiting and not eating while waiting for surgery. Your baby’s doctor will talk about the timing and the details of the surgery with you.

At the time of the surgery your baby will have general anesthesia. This means we will give your baby medicine to make them sleep and not have pain during the surgery. A small cut (incision) is made over the belly (abdomen). The surgeon will open the thickened stomach muscle so that food can pass out of the stomach more easily. The surgery usually takes less than 1 hour, and your baby will be in the recovery room for about another hour. You can expect your baby to stay in the hospital for 1 to 2 days after the surgery,

We partner with you to prevent and relieve your baby’s pain as much as possible. You know your baby best. We encourage you to take an active part in your baby’s recovery by talking with your care team about how your baby expresses pain.

After any surgery your baby is likely to have some pain and discomfort. No matter the level of your child’s pain, we join you to assess and respond right away. We will give medicines to keep your baby comfortable while in the hospital. Your baby’s doctor will prescribe pain medicine. When you go home, you can continue giving acetaminophen (Tylenol) following the doctor’s instructions. Check with your baby’s doctor first before giving any type of medicine to your baby.

Your baby will likely start to feed about 4 hours after surgery. Usually, your baby will be bottle fed on-demand with formula or breastmilk. If your baby vomits, they will need to wait for 2 hours before starting with on-demand feeds again. After at least 12 hours after surgery, and as soon as your baby is able to eat regular full-strength formula or breast milk for several hours, your baby can go home.

You may have noticed that your breasts are softer and that your milk supply has decreased. This is a normal response if your baby has not been eating well for several days. It is important that you use a hospital-grade electric breast pump while your baby is not eating so that you are able to make more milk.

If you have a full milk supply, while your baby is not breastfeeding, it is important that you pump every 2 to 3 hours or as often as your baby would normally breast feed. This will help to maintain your supply until your baby is ready to breastfeed again. The hospital has a place for you to store the milk you pump.

You will be able to breastfeed once we know your baby is able to successfully take a few bottle feedings. Ask your baby’s nurse to contact the lactation support team if you need help increasing your milk supply.

Your baby will need slower feedings with more frequent burping for a few days. Hold your baby upright to eat as well as after the feeding. Placing your baby on the right side when lying down will help to empty the stomach. After 3 to 4 days, you can resume your usual routine for feeding your baby.

• If skin glue (Dermabond) is used to cover the cut, it is OK to bathe and shower 2 days after surgery.
• If Steri-Strips are used to cover the cut, then it is OK to shower 2 days after surgery but no tub bathing or swimming for a week after surgery. These will usually fall off or peel off in 10 to 14 days.
• The cut will be closed with dissolvable stitches. You will not see any stitches on the outside skin.

Your baby does not need to limit any activities. You can take care of your baby like normal.

• Schedule an appointment with your baby’s primary care provider 1 to 3 days after leaving the hospital for a weight check.
• A nurse from general surgery clinic will call you 5 to 7 days after the surgery to see how your baby is doing. If your baby is doing well, you will not need to come in for a general surgery clinic visit. Your child’s primary care provider will continue to provide routine care.
• Vaccines may continue on schedule.

Please call your baby’s doctor if your baby has:

• Fever greater than 100° F (37.8°C)
• Vomits more than 3 times in 12 hours
• Redness, drainage or opening at the incision site
• Not making at least 3 wet diapers each day

If you have any other questions about the health of your baby, please call the general surgery clinic at 206-987-2794. After hours or on weekends call 206-987-2000 and ask for the “general surgery attending on-call.”